The simple question that can save the lives of physicians

Yesterday I woke up to a startling realization: Like the dozens of women I treat, I will soon be entering “the change” as they call it, and I instantly was catapulted on to the other side of the exam table. While all the symptoms are not present, I’ve been noticing the signs, and when I reviewed the blood work that was done last week, it was clear. The “M” word is coming soon.

I’ve never been one to fight the biological clock, but yesterday I found myself in a state of frustration, fear, and sadness. “I’m only 42. I don’t even feel 40. I don’t want to deal with all of the implications that come with the depletion of hormones. So, I pull from my own integrative knowledge, and frantically go online to find the supplements I know will enhance the little bit of oomph my ovaries still have. I do the exact thing I often try to discourage my patients from doing. Go figure.

We are facing the same things our patients are in our own lives every day.

We as physicians are faced daily with the effects of illness, death, dying and the aging process through our patients. We also deal with relationship problems, divorce, financial strain, challenges with our children and aging parents just like our patients do. So, what happens when we begin to experience the very thing that we advise and treat our patients on daily especially when it is difficult for us to bring ourselves to be the patient. We may sometimes forget that we are not beyond the physical and emotional ups and downs that we treat in our patients, we as physicians must face that we are human too. This is why we must take care of ourselves as a community by taking care of each other. Say what? “Don’t I take care of enough people already?” The answer to that is yes, and that is precisely why we need to take care of each other.

What exactly do you mean by that?

When I am feeling sad, hopeless, scared about my own mortality, the last person I’d feel safe to call is a colleague. We as a community do not make it safe to open up to each other when we are in distress. In fact, we either largely avoid our colleagues when they are in distress or worse we try to diagnose and treat them … label them as we do our patients. Even though we are doing the latter in an attempt to be helpful, this approach can cause further isolation and ultimately lead to a darker fate.

Research shows that approximately 400 physicians commit suicide each year.

We know that the prevalence of depression and suicide is widely under-reported. In my residency program, I was moments away from swallowing a bottle of Percocet after a knee surgery, and I had been depressed for months. Up until that point, I had told no one that I was suffering. And while I did something most doctors don’t (I asked for help), a good friend of mine didn’t and only six years later, he shot himself.

It’s often a detrimental surprise to the colleagues of the doctor who had seen him or her daily, often with no awareness that there was even a problem.

We are conditioned to push on when we are struggling. We are taught from the time we enter medical school to never show weakness. It is so ingrained that even we forget that we are human, and not the robot, lone ranger, superheroes that others sometimes see us as. How, then can we take care of each other?

We can start simply by asking “How are you doing?” I don’t mean that fast walk by type of “how’re you doing” while barely stopping to hear the answer. I mean a genuine stop, look them in the eye, “how are you doing, really?”

The answer may be “fine.” Whether or not they are fine is not the point (remember, your colleague is just as conditioned as you are), the point is someone took the time to care enough to ask in a way that begged for a real answer. You have planted the seed that you care. The more we do this for each other, the more we will connect. Connection leads to authentic conversation, and that could save your colleague’s life.

Is that it? Are you saying that asking how someone is doing will solve this enormous problem?

Of course not! We are only at the beginning of creating solutions to this insidious disease of our culture that leads to physician burnout, exhaustion, depression, and suicide. It’s a mountain with no top. We must start with ourselves. Recognizing that you are human is first. Give yourself permission to take care of yourself. Create a strategy that has your life really work. As you work your own plan, then and only then will you begin have the space to connect with your colleagues in a way that makes a difference.

Believe me, whether your colleague admits it or even recognizes the impact, by making repeated attempts to connect, you are speaking to the unconscious mind. You are telling them “Hey, you are not alone.” Perhaps if someone had been asked the question “How are you doing, really?”, I would not have found myself staring down the barrel of that bottle of Percocet 14 years ago. Perhaps if someone had taken the time to ask, my dear friend and colleague that same question 8 years ago, he’d be alive today.